A model to transfer trial-based pharmacoeconomic analyses to clinical practice.

This article deals with the question of how to handle costs to enhance medication adherence in trial-based pharmacoeconomic analyses. It argues that resources to improve patient adherence have a clearly distinguishable impact on costs and utility and thus are relatively easy to exclude when transferring trial-based pharmacoeconomic analyses to clinical practice. It proposes a model that adjusts trial-based incremental costs and effectiveness for lower medication adherence in clinical practice. It shows that, contrary to conventional wisdom, drug cost effectiveness in clinical practice can be better than in clinical trials. This may have implications for policy recommendations, depending on how close trial-based cost effectiveness is to the maximum willingness to pay. In many situations, the adjustment may not result in a change in policy recommendations.